198602080-4-3-2023-28-AS-FFIS-CRZ4EA-20230519190202

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602080
Report Date: 04/03/2023
Date Signed: 04/03/2023 02:30:19 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/30/2023 and conducted by Evaluator Ashley Calderon

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230330092306

FACILITY NAME:	HOURGLASS HOME		FACILITY NUMBER:	198602080
ADMINISTRATOR:	MARIA BINOTAPA		FACILITY TYPE:	735
ADDRESS:	1121 HOURGLASS PLACE		TELEPHONE:	(909) 631-8521
CITY:	DIAMOND BAR	STATE: CA	ZIP CODE:	91765
CAPACITY:	6	CENSUS: 2	DATE:	04/03/2023
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Administrator- Maria Binotapa		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff are not adequately trained

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Calderon conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with DSP worker Jennifer Discipulo and at 10:45am met with Administrator Maria Binotapa to explain the reason for the visit.

The investigation consisted of:LPA Calderon collected copies of Staff and Client rosters. LPA also conducted a tour of entire inside of the facility with DSP worker Jennifer Discipulo. LPA observed two (2) clients in the facility and (2) staff at the time of the visit and (4) clients were at day program. LPA reviewed Administrator's File, Staff #1- Staff #5 (S1-S5) files and collected documents pertinent to the investigation regarding training. LPA Calderon interviewed Administrator Maria,S1, and Client #1 and Client #2 (C1 and C2) whom were present at the time of visit. LPA Calderon interviewed telephonically Quality Assurance Administrative Assistant (Q.A.A.A) from San Gabriel Pomona Regional Center (SG/PRC) and interviewed Service Coordinator from SG/PRC. LPA Calderon reviewed Corrective Action Plan (CAP) received sent by Q.A.A.A.
(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230330092306

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: HOURGLASS HOME	FACILITY NUMBER: 198602080
	VISIT DATE: 04/03/2023

NARRATIVE

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Investigation revealed the following: Regarding Allegation: Staff are not adequately trained.
LPA interview with Clients, C1 and C2 both denied the above allegations and state staff are trained and staff met their needs pertaining to food prepping, medication administration and hygiene. LPA Calderon interview with Administrator Maria stated staff denied the above allegation stated staff receive training on-going at least three times a month. Maria stated to ensure staff are trained by receiving on-site training, continuing education, and in-service training and training by a behavior consultant. Maria stated Direct Staff Professional Training (DSP) is for Regional Center (RC) and is scheduled for staff and it is a requirement for RC different from Licensing. LPA Calderon interview with Service Coordinator from SG/PRC stated training incomplete for DSP a requirement for Regional Center, no other training concerns during Annual Visit regarding staff training. LPA Interview with Q.A.A.A stated Correction Action Plan is based on DSP training requirement by R.C. LPA reviewed a total of 6 staff files and reviewed supporting training documentation which includes but not limited to: training's consisted of: food, nutrition and menu planning, sanitation/housekeeping, medication administration, client rights, supervision, communication, and signs of illnesses ,behavior plan and intervention, community services/resources and emergency procedures. LPA reviewed CAP stating training on DSP is a requirement that pertains to Title 17 Regulation used by Regional Center.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview held and a copy of the report was provided to Administrator Maria Binotapa.

NAME OF LICENSING PROGRAM MANAGER: Fernando Fierros
NAME OF LICENSING PROGRAM ANALYST: Ashley Calderon
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023

LIC9099 (FAS) - (06/04)

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